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What more can be done?

When students show signs of mental illness, universities must walk a fine line.

By ALISA ULFERTS
Published April 22, 2007

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As Seung-Hui Cho's history of mental disturbance is revealed piece by unsettling piece, the Virginia Tech killer's story has people across the country wondering whether the university should have done more to prevent the threat Cho ultimately became.

After all, the student who killed 32 people Monday before turning a gun on himself had left a wake of alarming behavior dating to well before the massacre: accusations of stalking, violent writings, cryptic e-mails, an imaginary girlfriend and a brief stay in a psychiatric ward.

But when it comes to students in mental distress, the trend in recent years has been for school officials to overreach by automatically suspending those who seek or receive psychiatric intervention, according to advocates for the mentally ill.

Spurred by a handful of wrongful death lawsuits filed by parents, some universities adopted policies that barred students deemed suicidal from campus unless they agreed to withdraw from the school and seek treatment.

Some of those students have since sued, successfully, under the Americans with Disabilities Act. Others have filed complaints with the Department of Education's Office of Civil Rights. Even before the shooting at Virginia Tech, colleges around the country had begun looking closely at their policies to determine whether they had struck an appropriate balance among individual rights, group safety and the schools' own liability.

What effect the Virginia Tech killings will have on those efforts isn't yet clear. But whatever policies schools adopt, the tragedy at the school nestled in the Blue Ridge Mountains has highlighted the dilemmas universities face while trying to cope with a growing amount of mental illness on their campuses.

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Elizabeth Shin set herself on fire in her dorm room at the Massachusetts Institute of Technology in April 2000. It was the sophomore's second attempt at suicide; a year earlier she had spent a week in the hospital after overdosing on Tylenol with codeine.

Shin died three days later from her burn injuries. According to reports, Shin had told two fellow students and a dorm supervisor at MIT about her intent to kill herself. Meetings were held, and an appointment was set up for her to see a school psychiatrist.

But because she had made her plans clear to the school, her parents filed a $27-million wrongful death lawsuit against MIT and individual staff members in 2002.

It was the lawsuit heard around the academic world. Colleges and universities, fearing the case could bring a flood of similar lawsuits, began writing policies to protect themselves from liability and protect other students from the possible threat posed by mentally unstable students.

According to the Centers for Disease Control and Prevention, the actual suicide rate among all young people has been declining slowly since 1992, a fact mental health advocates attribute to aggressive prevention campaigns. An estimated 1,100 college students will commit suicide this year, according to the Jed Foundation, an organization devoted to preventing suicide among college students.

Nonetheless, 92 percent of college counseling center directors who responded to an annual survey in 2006 said they had seen an increase in the number of seriously mentally ill students on campus in recent years.

"Because of the advances of psychiatry, there are now students who can attend college who never could before," said Joanna Locke, a doctor and program director for the Jed Foundation.

Mentally ill students who can manage with outpatient treatment at home don't always seek the same level of care on their own at college, Locke said. Add to that the pressures of college life, and students who have never had trouble before can develop depression and other illnesses, she said.

"The age range of most college students is the time when many disorders, such as bipolar disorder, will first appear," Locke said.

With that in mind, and aware of the potential liability, universities began after 2002 to take a harder stance against students who had harmed themselves or who appeared ready to harm themselves:

George Washington University sophomore Jordan Nott had been ruminating about a friend's recent suicide one autumn night in 2004 when, alarmed by his own dark thoughts, he asked a friend to go with him to the university hospital.

Within hours of being admitted, Nott was served notice that he was barred from returning to his dorm room. Three days later, according to a lawsuit Nott filed about a year later, the university told him he had to withdraw from school or face suspension, expulsion or possibly even criminal charges.

Nott ultimately transferred to the University of Maryland, and George Washington University was pilloried for its harshness in dealing with a student who was in mental distress. Nott said he would never have sought help if he had known the information would end up in the hands of administrators.

"Anything that would discourage students from getting mental health treatment is counterproductive," said Karen Bower, a staff attorney for the Bazelon Center for Mental Health Law, which represented Nott in the case, settled last year.

A similar occurrence took place at Hunter College in New York, where a student dialed 911 in 2003 after taking a large number of Tylenol pills. When she returned to her dorm after treatment, she found that the locks to her dorm room had been changed. She was allowed to remove her belongings only under the supervision of a campus guard, according to her attorneys.

The student, called Jane Doe in court filings, sued the school in 2004 and last year settled for $65,000 and a promise from the school to change its policy.

Several other schools - including Bluffton University in Ohio, Woodbury University in California and DeSales University in Pennsylvania - have received written rebukes from the Department of Education's Office of Civil Rights for denying students access to campus facilities because of a mental disability.

Wayne Griffin, associate director of the counseling center at the University of Florida, said the various lawsuits show how difficult it can be for schools to act when faced with a student who poses a potential risk for harm to himself or others.

"The gray area is when we can tell that they are really sad, but they don't want help, and they're not saying anything that would make them an imminent threat," Griffin said.

He works with faculty and staff to help them identify and approach students who are at risk. But predicting when a disturbed person will cross a threshold and become dangerous is very difficult, he said.

"They don't cross that line until they do - and that's the horrible part."

Times researcher Caryn Baird contributed to this report. Alisa Ulferts can be reached at ulferts @sptimes.com or (727) 892-2379.